Asian Journal of Case Reports in Medicine and Health

Tubercular liver abscess (TLA) is an uncommon manifestation of extrapulmonary tuberculosis, often misdiagnosed as pyogenic or amoebic abscess. We report the case of a 30-year-old male presenting with right hypochondrial pain, diagnosed with TLA confirmed by CBNAAT positivity in aspirated pus. The patient was successfully managed with percutaneous pigtail drainage and antitubercular therapy (ATT). This case underscores the importance of considering tuberculosis in the differential diagnosis of hepatic abscesses in endemic regions and highlights the role of minimally invasive drainage combined with ATT. The clinical presentation of tubercular liver abscess (TLA) is often nonspecific, with patients typically reporting fever, vague abdominal pain, malaise, and weight loss. On physical examination, hepatomegaly is a frequent finding, whereas jaundice is uncommon and, when present, usually indicates biliary involvement due to extra‑ or intrahepatic obstruction. Importantly, the severity of liver disease does not correlate with the occurrence of jaundice. By recognizing and treating such manifestations early, clinicians can ensure timely recovery and strengthen the collective understanding of this uncommon presentation. This case reminds us that in the battle against tuberculosis, even its rarest shadows must be unmasked, because forewarned is forearmed.